Last Modified: 5/10/2018 Location: FL, PR, USVI Business: Part A, Part B
QMB remittance advice issue
Payers secondary to Medicare are not able to process some direct billed claims due to patient responsibility deductible and coinsurance amounts on the Medicare remittance advice showing zero. On October 2, 2017, change request 9911 modified Qualified Medicare Beneficiary (QMB) claims to indicate QMB status of patients and reflect zero cost-sharing liability. The change resulted in issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the remittance advice.
On December 8, 2017, Centers for Medicare & Medicaid Services (CMS) systems will revert back to the previous display of patient responsibility for QMBs on the Medicare remittance advice. After this temporary fix, a permanent solution is tentatively scheduled for summer 2018. First Coast Service Options will provide updates as it monitors the situation.
Please refer to this article on the CMS website for a guide to identify cost-sharing amounts. Providers may also submit any questions to firstname.lastname@example.org. Note that the provider call center is unable to provide a resolution at this time.
Current processing issues
Here is a link to a table of current processing issues for both Part A and Part B.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.